Medical check-up can be accomplished in different ways, they are: Clinical audit which is carried out so that procedures are checked before they occur. It is usually linked to procedures or issues health plan guides and is performed by physicians (Greek, 2005; CIAMPONE, 2004).
In the health sector, developing professionals must be trained specifically for this function (BRITO, 2006).
Medical operational control is the time in which procedures are checked during and after the Auditor acts with the service, with the aim of monitoring the patient’s condition in the hospital, giving rise and management of relocation, helping the release of procedures or materials and high-cost medicines and also quality control of the care provided.
- It is in this period that the auditor can suggest, with the agreement of the treating physician, another medical alternative for the user, such as chronic case management (Greek, 2005; GAIDZINSKI, 2004).
- Medical analytical control covers the activities of examining collected data from prevention and operational control and conferring with management and indicators from other organizations.
In this process, reviewers should have knowledge relevant to health and administrative indicators, and that it hurts to use tables, charts and databases. In this way, they are good at gathering information related to the health plan, as well as about the problems found in each health service provider.
- Consequently, these analyzes substantially cooperate for the management of the resources of the organization or public enterprises (white, 2001; ATTIÊ, 2005).
- There are various ways and methods of health control, which direct the work on a specific character, but in general, they all state that the auditor is responsible in his activities (MELO, 2008).
Clinical audit activity is mentioned in the list of medical functions
Through Resolution No. 1.627 CFM / 2001: “Activities of coordination, direction, leadership, competence, control, supervision and teaching of private medical procedures include health acts and must be used exclusively by the doctor “.
Resolutions defining medical specialties, such as CFM resolution no. 1.763 / 2005, leave the question of control to another instance, according to the text: “audit will be designated as a special area and will receive another type 3 specification”.
- The audit included the operation clinical audit of a high-count-labeled hospital visit – what happens after the patient is discharged.
- However, still in the hospital environment, this process is prior to this account being sent to the payer origin, having the auditor the right to complete medical records for review.
In this case, any shortcomings or discrepancies can be negotiated before the presentation of the hospital bill paying source, with mutual and formal agreement. Another possibility is the auditing of the accounts being hit at the headquarters of the paying organization. On the audit are the Standards of Hospital Infection Control Committees (CCIH) (KOTLER, 2005; FALK, 2001).
Audit, however, is a function in the main application in all systematics / mechanical gear / composing with business planning, implementation, domain administrative cycle, quality expansion to be practiced by all professionals / participants of organizations (SANTOS, 2008; DRINK, 2003).